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�ate — Pu011c Wo�ks Perm�l s <br /> Application For Biap.oeoi.+ <br /> PUBLIC WORKS PERMIT PublicWorksFee <br /> To�al Fee 5 <br /> Less NOPI.Fee PaIC S <br /> Balance Due $ <br /> Print or Type Only <br /> PLan Check No: C 42554 SEPA <br /> Owner Applicat.Date: 11/02/93 Z;p Phone <br /> Job Address: 16 E INTERCITY AVE <br /> Owner: BAXTER BRADLEY ' <br /> Tenant: <br /> Proposed Use: SINGLE FAMILY RESIDENCE <br /> Applicant Desc. of Work: Zip Phone <br /> ADDITION <br /> Describe Proposed WarP OFFICE SET JOB SET <br /> APPROVED FOR PERMIT: DATE_/_/_ BY <br /> W <br /> Project Address(if known) � <br /> Attach four(4) cepies of plans tor proposed work- Draw to scale antl note the lollowing as applicable: �� <br /> • Properry Lines • Centerline ol sireet /w <br /> • Outline and dimensions ot all existing and • Indicate Norih V, <br /> proposed s�ructures on ihe lot • Show any proposed grading changes <br /> • Existing and proposed utilities • Show measurements � <br /> DO NOT WRITE BELOW THIS LINE <br /> PERMIT CONDITIONS O <br /> 1.All calls for inspection shall be m;de 24 hrs.in advance-phone 259•8810. � <br /> 2.AR work shall be performed in accordance with this permit and current City of Everett Design and Construction <br /> Standards and Specifications. � <br /> 3.Call Location UnAerground Service 48 hrs.before you dig.TOLL FREE NUMBER 1-800•424•f'i555. � <br /> O <br /> PUBLIC WORI<S PERMIT � <br /> NOT REOUIRED � <br /> BY �� � <br /> DATE �� S �3 <br /> a <br /> ACKNOWLEDGEMENT OF CONDITIONS <br /> The undersigned owner/applicant hereby agrees to hold and save harm- <br /> less the Ci�y of Everetl Irom any and all claims for damages, costs, <br /> expenses, or causes of action Ihat may arise because ol installation <br /> and maintenance of ihe improvement or other righl-of�way use hereto <br /> applied for and lurther agrees to remove same upon nolice from the <br /> Approved lor Construction Date City and to replace public property damaged ihereby. <br /> FINAL INSPFCTION Date <br /> Approved as Constructed Si9nature of Applicant Date <br /> �Ar� PUBUC WORKS DEPARTMENT WORK AUTHORIZED 8Y THIS PERMIT MUST BE STARTED WITHIN <br /> 3200CedarSlreet 180 DAYS OF DATE PERMIT IS ISgUED AND THEREAFTER IS TO <br /> Everett,WA 98207 BE DILIGENTLY PURSUED TO COMPLETION. THIS PERMIT MAY BE <br /> Phone:259�d810 CANCELIED BY THE CITY UPON ANY STOPPAGE OF WORK ON THIS <br /> PROJECT OVER 90 DAYS DURATION. <br />